title: Three-dimensional prediction of free-flap volume in autologous breast reconstruction by CT angiography imaging.
abstract: OBJECTIVE
  The diagnostic use of computer tomography angiography (CTA) to identify perforating blood vessels for abdominal free-flap breast reconstruction was extended to estimate the three-dimensional (3D) preoperative flap volume and to compare it with the real intraoperative flap weights in order to (1) evaluate the accuracy of CTA-based 3D flap volume prediction, and (2) to analyze abdominal tissue estimation for required breast volume reconstruction.
  
  
  METHODS
  Preoperative CTA was performed in 54 patients undergoing unilateral breast reconstruction with a free, deep, inferior epigastric artery perforator flap. 3D flap volumes ([Formula: see text]) based on CTA data were calculated and compared with the actual intraoperative flap weight (g). In addition, a breast volume to flap volume ratio was calculated to analyze whether the estimated 3D abdominal flap volume would match that of the breast to be removed.
  
  
  RESULTS
  40 CTA data sets (74.1 %) fulfilled the technical requirements for a reliable determination of flap volume. 3D CTA flap volume prediction showed no relevant differences to the actual flap weight (p = 0.44) and high correlations (r = 0.998, [Formula: see text]), allowing a prediction accuracy within 0.29 [Formula: see text] 3.0 % (range: from [Formula: see text]8.77 to 5.67 %) of the real flap weight. Significantly larger flap volumes were harvested compared with the actually required breast volumes ([Formula: see text]), leading to an average of 21 % of the remnant flap tissue potentially being discarded.
  
  
  CONCLUSIONS
  CTA-based 3D flap volume prediction provides accurate preoperative guidelines concerning the needed amount of abdominal tissue that can be harvested to achieve acceptable symmetry.
authors.affiliation: Research Group-Computer Aided Plastic Surgery (CAPS), Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 , Munich, Germany, m.eder@lrz.tum.de.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Eder
authors.forename: Stefan
authors.initials: S
authors.lastname: Raith
authors.forename: Jalil
authors.initials: J
authors.lastname: Jalali
authors.forename: Daniel
authors.initials: D
authors.lastname: Müller
authors.forename: Yves
authors.initials: Y
authors.lastname: Harder
authors.forename: Martin
authors.initials: M
authors.lastname: Dobritz
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Papadopulos
authors.forename: Hans-Günther
authors.initials: HG
authors.lastname: Machens
authors.forename: Laszlo
authors.initials: L
authors.lastname: Kovacs
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D019074:Epigastric Arteries; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult